Patient education is a priority and desired by both patients and providers in the care of chronic kidney disease (CKD). Yet, even in the setting of frequent interactions with health care providers, patients often report low knowledge of chronic diseases, such as diabetes, heart disease, and kidney disease. This suggests ineffective communication between patients and providers. Recently, the potential risks of erythropoiesis stimulating agents (ESAs) have been described and the FDA has mandated ensuring patients are informed participants in this treatment as part of a Risk Evaluation and Mitigation Strategy (REMS). Risk information remains a complex concept for many patients. In patients with kidney disease and receiving ESAs anemia knowledge is often poor. One explanation may be that there are few resources available to providers to promote effective discussions about this complex care issue. The objectives of this application are to: (1) characterize the current practice, preferences, and barrier to counseling about anemia management in kidney disease among a national sample of nephrologists; and (2) to develop and examine the feasibility of an efficient tool to facilitate provider-patient communication to improve patient anemia knowledge and treatment satisfaction. These objectives are in concert with the parent K23 application's goal to determine barriers to efficient and effective health communication for patients with kidney disease. This application furthers the overall goal of the parent award by extending this important area of investigation from end-stage renal disease (ESRD) to a component of care relevant to patients with advanced chronic kidney disease not receiving dialysis. The proposed educational intervention will be designed specifically to permit transplantation to a variety of care settings - including those with vulnerable patient populations, such as those with low health literacy. Additionally, in accordance with the goals of the proposal, this study will further expand the experience and expertise of the P.I. in large national survey design, administration and analyses. This will further advance the pathway of the P.I. to establishing an independent research career. PUBLIC HEALTH RELEVANCE: Physician delivered patient education about anemia management, including its potential risks, for patients with kidney disease is an essential component of comprehensive care. This study will identify provider barriers to effective communication about anemia management and develop efficient, useful tools to facilitate patient-provider interactions and improve patient knowledge and satisfaction with anemia therapy.